ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAF
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Network:Location #
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School:Location #
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Please make sure have attached a current price quote.
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Date:
Type in yellow spaces only
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Identify the Special Ed Population/program who will use the requested materials, (i.e. LS, MDS, LSS)
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Describe in detail how the requested materials will assist these students to reach their educational goals. (Please be specific)
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I (we) have reviewed the components of the proposal and support the content and need. I (we) understand that all property ordered
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through ACCESS funds remain the property of the School District of Philadelphia at the school site of origin. We accept responsibility for
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for assuring approved materials are ordered and distributed to the appropriate parties.
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Please PrintJobProposer's
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Submitted by:Title:Signature:
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Please make sure have attached a current price quote.
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Vendor/ Supplier Name:Vendor/ Supplier Number:
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Vendor/ Supplier Address:Vendor/ Supplier Phone #:
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Purchase Order Form Information to be transferred to SDP purchasing system. The same guidelines that apply to regular requisitions apply here.
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Fill in proposal allotted amount
Beginning Total
 $ -
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Item DescriptionItem #QntyUnit Price Discount by itemSubtotal after disc.S & H %S&H flat rateTotal Price
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1 $ - 0% $ - $ -
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9Subtotal $ - $ -
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Discount from Total Order0% $ - $ -
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Please include exact % of Shipping charge (ex. 12% or zero if free
or flat rate)
Enter here0% $ - $ -
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Order Total $ -
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Balance RemainingUnder/(Over) $ -
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Shipping and handling must be included as quoted; if it is free enter zero. Only use the quoted pricing when completing this form. Thank you.
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Do not add additional lines to purchase order form if you need to add more items scroll down to next page.
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Comment:
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Please make sure have attached a current price quote.
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Vendor/ Supplier Name:Vendor/ Supplier Number:
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Vendor/ Supplier Address:Vendor/ Supplier Phone #:
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Purchase Order Form Information to be transferred to SDP purchasing system. The same guidelines that apply to regular requisitions apply here.
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Balance Remaining
 $ -
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Item DescriptionItem #QntyUnit Price Discount by itemSubtotal after disc.S & H %S&H flat rateTotal Price
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1 $ - 0% $ - $ -
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2 $ - 0% $ - $ -
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3 $ - 0% $ - $ -
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7 $ - 0% $ - $ -
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8 $ - 0% $ - $ -
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9Subtotal $ - $ -
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Discount from Total Order0% $ - $ -
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Please include exact % of Shipping charge (ex. 12% or zero if free
or flat rate)
Enter here0% $ - $ -
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Order Total $ -
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Balance RemainingUnder/(Over) $ -
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Shipping and handling must be included as quoted; if it is free enter zero. Only use the quoted pricing when completing this form. Thank you.
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Do not add additional lines to purchase order form if you need to add more items scroll down to next page.
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Comment:
Click SAVE AS to save for your files
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Please make sure have attached a current price quote.
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Vendor/ Supplier Name:Vendor/ Supplier Number:
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Vendor/ Supplier Address:Vendor/ Supplier Phone #:
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Purchase Order Form Information to be transferred to SDP purchasing system. The same guidelines that apply to regular requisitions apply here.
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Balance Remaining
 $ -